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Margin Assessment in Breast Conserving Surgery

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Breast Oncoplasty and Reconstruction

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Abstract

Breast conservative surgery (BCS) is aimed at complete removal of breast tumor with negative surgical margins and acceptable aesthetic outcomes. An attempt to conserve breast tissue for better cosmetic outcomes sometimes leads to positive surgical margins and subsequently results in revision surgery and almost two-fold increase in IBTR. For maintaining the fine balance between cosmesis and optimal margins, several preoperative and intraoperative radiological and pathological interventions have been tried and the field is still evolving.

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References

  1. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002 Oct 17;347(16):1233–41.

    Article  PubMed  Google Scholar 

  2. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002 Oct 17;347(16):1227–32.

    Article  PubMed  Google Scholar 

  3. Jacobson JA, Danforth DN, Cowan KH, d’Angelo T, Steinberg SM, Pierce L, Lippman ME, Lichter AS, Glatstein E, Okunieff P. Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med. 1995 Apr 6;332(14):907–11.

    Article  PubMed  CAS  Google Scholar 

  4. van Dongen JA, Voogd AC, Fentiman IS, Legrand C, Sylvester RJ, Tong D, van der Schueren E, Helle PA, van Zijl K, Bartelink H. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of cancer 10801 trial. J Natl Cancer Inst. 2000 July 19;92(14):1143–50.

    Article  PubMed  Google Scholar 

  5. Fisher B, Dignam J, Wolmark N, Mamounas E, Costantino J, Poller W, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: Findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol. 1998;16:441–52.

    Article  PubMed  CAS  Google Scholar 

  6. Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, Klimberg S, Chavez-MacGregor M, Freedman G, Houssami N, Johnson PL, Morrow M. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Int J Radiat Oncol Biol Phys. 2014 Mar 1;88(3):553–64. https://doi.org/10.1016/j.ijrobp.2013.11.012.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Landercasper J, Whitacre E, Degnim AC, Al-Hamadani M. Reasons for re-excision after lumpectomy for breast cancer: insight from the American Society of Breast Surgeons Mastery(SM) database. Ann Surg Oncol. 2014;21(10):3185–91.

    Article  PubMed  Google Scholar 

  8. Rivere AE, Chiasson KF, Corsetti RL, Fuhrman GM. An assessment of margins after lumpectomy in breast cancer management. Am Surg. 2016;82(2):156–60.

    Article  PubMed  Google Scholar 

  9. McCahill LE, Single RM, Aiello Bowles EJ, et al. Variability in re-excision following breast conservation surgery. JAMA. 2012;307(5):467–75.

    Article  PubMed  Google Scholar 

  10. Sheikh F, Pockaj B, Wasif N, Dueck A, Gray RJ. Positive margins after breast-conserving therapy: localization technique or tumor biology? Am J Surg. 2011;202(3):281–5.

    Article  PubMed  Google Scholar 

  11. Singh M, Singh G, Hogan KT, Atkins KA, Schroen AT. The effect of intraoperative specimen inking on lumpectomy re-excision rates. World J Surg Oncol. 2010;8:4.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Morrow M, Van Zee KJ, Solin LJ, Houssami N, Chavez-MacGregor M, Harris JR, et al. Society of surgical oncology–American society for radiation oncology–American society of clinical oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. Pract Radiat Oncol. 2016;6(5):287–95. https://doi.org/10.1016/j.prro.2016.06.011.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Menezes GL, Knuttel FM, Stehouwer BL, Pijnappel RM, van den Bosch MA. Magnetic resonance imaging in breast cancer: a literature review and future perspectives. World J Clin Oncol. 2014;5(2):61–70. https://doi.org/10.5306/wjco.v5.i2.61.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Berg WA, Gutierrez L, NessAiver MS, Carter WB, Bhargavan M, Lewis RS, Ioffe OB. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 2004;233:830–49. [PMID: 15486214 DOI: 10.1148/radiol.2333031484]

    Article  PubMed  Google Scholar 

  15. Boetes C, Mus RD, Holland R, Barentsz JO, Strijk SP, Wobbes T, Hendriks JH, Ruys SH. Breast tumors: comparative accuracy of MR imaging relative to mammography and US for demonstrating extent. Radiology. 1995;197:743–7. [PMID: 7480749]

    Article  PubMed  CAS  Google Scholar 

  16. Zhang Y, Ren H. Meta-analysis of diagnostic accuracy of magnetic resonance imaging and mammography for breast cancer. J Can Res Ther. 2017;13:862–8.

    Article  Google Scholar 

  17. Peters NH, van Esser S, van den Bosch MA, Storm RK, Plaisier PW, van Dalen T, Diepstraten SC, Weits T, Westenend PJ, Stapper G, Fernandez-Gallardo MA, Borel Rinkes IH, van Hillegersberg R, Mali WP, Peeters PH. Preoperative MRI and surgical management in patients with nonpalpable breast cancer: the MONET – randomised controlled trial. Eur J Cancer 2011 April;47(6):879–886. doi: https://doi.org/10.1016/j.ejca.2010.11.035. Epub 2010 Dec 30.

  18. Turnbull LW, Brown SR, Olivier C, Harvey I, Brown J, Drew P, Hanby A, Manca A, Napp V, Sculpher M, Walker LG, Walker S, COMICE Trial Group. Multicentre randomised controlled trial examining the cost-effectiveness of contrast-enhanced high field magnetic resonance imaging in women with primary breast cancer scheduled for wide local excision (COMICE). Health Technol Assess. 2010 Jan;14(1):1–182. https://doi.org/10.3310/hta14010.

    Article  PubMed  CAS  Google Scholar 

  19. Houssami N, Ciatto S, Macaskill P, Lord SJ, Warren RM, Dixon JM, Irwig L. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol 2008 July 1;26(19):3248–3258. doi: https://doi.org/10.1200/JCO.2007.15.2108. Epub 2008 May 12.

  20. Bleicher RJ, Ciocca RM, Egleston BL, Sesa L, Evers K, Sigurdson ER, Morrow M. Association of routine pretreatment magnetic resonance imaging with time to surgery, mastectomy rate, and margin status. J Am Coll Surg. 2009 Aug;209(2):180–187.; quiz 294–5. doi: https://doi.org/10.1016/j.jamcollsurg.2009.04.010. Epub 2009 Jun 18. Erratum in: J Am Coll Surg 2009 Nov;209(5):679. PMID: 19632594; PMCID: PMC2758058.

  21. Turnbull L, Brown S, Harvey I, Olivier C, Drew P, Napp V, Hanby A, Brown J. Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomised controlled trial. Lancet. 2010 Feb 13;375(9714):563–71. https://doi.org/10.1016/S0140-6736(09)62070-5.

    Article  PubMed  Google Scholar 

  22. Frank HA, Hall FM, Steer ML. Preoperative localization of nonpalpable breast lesions demonstrated by mammography. N Engl J Med. 1976;295(5):259–60. https://doi.org/10.1056/nejm197607292950506.

    Article  PubMed  CAS  Google Scholar 

  23. Moreno M, Wiltgen JE, Bodanese B, Schmitt RL, Gutfilen B, da Fonseca LM. Radioguided breast surgery for occult lesion localization – correlation between two methods. J Exp Clin Cancer Res. 2008;27:29.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Medina-Franco H, Abarca-Perez L, Garcia-Alvarez MN, Ulloa-Gomez JL, Romero-Trejo C, Sepulveda-Mendez J. Radioguided occult lesion localization (ROLL) versus wire-guided lumpectomy for non-palpable breast lesions: a randomized prospective evaluation. J Surg Oncol. 2008;97(2):108–11.

    Article  PubMed  Google Scholar 

  25. Jakub JW, Gray RJ, Degnim AC, Boughey JC, Gardner M, Cox CE. Current status of radioactive seed for localization of non palpable breast lesions. Am J Surg. 2010;199(4):522–8.

    Article  PubMed  Google Scholar 

  26. van Riet YE, Jansen FH, van Beek M, van de Velde CJ, Rutten HJ, Nieuwenhuijzen GA. Localization of non-palpable breast cancer using a radiolabelled titanium seed. Br J Surg. 2010;97(8):1240–5.

    Article  PubMed  Google Scholar 

  27. Luini A, Zurrida S, Galimberti V, Paganelli G. Radioguided surgery of occult breast lesions. Eur J Cancer. 1998;34(1):204–5.

    PubMed  CAS  Google Scholar 

  28. Monti S, Galimberti V, Trifiro G, et al. Occult breast lesion localization plus sentinel node biopsy (SNOLL): experience with 959 patients at the European Institute of Oncology. Ann Surg Oncol. 2007;14(10):2928–31.

    Article  PubMed  Google Scholar 

  29. van Esser S, Stapper G, van Diest PJ, et al. Ultrasound-guided laser-induced thermal therapy for small palpable invasive breast carcinomas: a feasibility study. Ann Surg Oncol. 2009;16(8):2259–63.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Shoma A, Moutamed A, Ameen M, Abdelwahab A. Ultrasound for accurate measurement of invasive breast cancer tumor size. Breast J. 2006;12(3):252–6.

    Article  PubMed  Google Scholar 

  31. Bathla L, Harris A, Davey M, Sharma P, Silva E. High resolution intra-operative two-dimensional specimen mammography and its impact on second operation for re-excision of positive margins at final pathology after breast conservation surgery. Am J Surg. 2011;202:387–94.

    Article  PubMed  Google Scholar 

  32. Allweis TM, Kaufman Z, Lelcuk S, Pappo I, Karni T, Schneebaum S, et al. A prospective, randomized, controlled, multicenter study of a real-time, intraoperative probe for positive margin detection in breastconserving surgery. Am J Surg. 2008;196:483–9.

    Article  PubMed  Google Scholar 

  33. Jin M, Kim JY, Kim TH, Kang DK, Han SH, Jung Y. Intraoperative specimen mammography for margin assessment in breast-conserving surgery. J Breast Cancer. 2019 Dec;22(4):635–40. https://doi.org/10.4048/jbc.2019.22.e58.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Urano M, Shiraki N, Kawai T, Goto T, Endo Y, Yoshimoto N, Toyama T, Shibamoto Y. Digital mammography versus digital breast tomosynthesis for detection of breast cancer in the intraoperative specimen during breast-conserving surgery. Breast Cancer 2016 Sep;23(5):706–711. doi: https://doi.org/10.1007/s12282-015-0628-5. Epub 2015 July 23.

  35. Esbona K, Li Z, Wilke LG. Intraoperative imprint cytology and frozen section pathology for margin assessment in breast conservation surgery: a systematic review. Ann Surg Oncol. 2012;19:3236–45.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Osborn JB, Keeney GL, Jakub JW, Degnim AC, Boughey JC. Cost-effectiveness analysis of routine frozen section analysis of breast margins compared with reoperation for positive margins. Ann Surg Oncol. 2011;18:3204–9.

    Article  PubMed  Google Scholar 

  37. Kobbermann A, et al. Impact of routine cavity shave margins on breast cancer re-excision rates. Ann Surg Oncol. 2011;18:1349–55.

    Article  PubMed  Google Scholar 

  38. Chagpar AB, et al. A randomized, controlled trial of cavity shave margins in breast cancer. N Engl J Med. 2015;373:503–10.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  39. Jones V, et al. Excising additional margins at initial breast-conserving surgery (BCS) reduces the need for re-excision in a predominantly African American population: a report of a randomized prospective study in a public hospital. Ann Surg Oncol. 2016;23:456–64.

    Article  PubMed  Google Scholar 

  40. Schwarz J, Schmidt H. Technology for Intraoperative Margin Assessment in breast cancer. Ann Surg Oncol. 2020;27:2278–87. https://doi.org/10.1245/s10434-020-08483-w.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Oncology, DR BRA-IRCH, AIIMS, New Delhi, India

    S. V. S. Deo, Ashutosh Mishra, Chitresh Kumar & Sandeep Bhoriwal

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  1. S. V. S. Deo
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  2. Ashutosh Mishra
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  3. Chitresh Kumar
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  4. Sandeep Bhoriwal
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Editors and Affiliations

  1. Department of Surgical Oncology, BRA-IRCH & National Cancer Institute, All India Institute of Medical Sciences, New Delhi, India

    S.V.S. Deo

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Deo, S.V.S., Mishra, A., Kumar, C., Bhoriwal, S. (2023). Margin Assessment in Breast Conserving Surgery. In: Deo, S. (eds) Breast Oncoplasty and Reconstruction. Springer, Singapore. https://doi.org/10.1007/978-981-99-5536-7_5

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  • DOI: https://doi.org/10.1007/978-981-99-5536-7_5

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